Meet Regulatory Demands and Ensure Compliance

The Appeals & Grievances module streamlines and consolidates the entire appeals management process to help you meet regulatory demands for timely resolution and correspondence.

The module is configured to record all the elements necessary to track and report on required turnaround times — by line of business and by complaint/grievance type. Each grievance type can be configured to automate the workflow associated with each type, including:

Assignment of tasks to appropriate staff

Tracking completion of each task

Automatically generating the appropriate correspondence to the member

Ensure Compliance with Configurable Appeal Workflows

Workflows, turnaround requirements and correspondence templates can be configured for each appeal type, allowing your organization to maintain compliance for appeal and grievance processes across multiple lines of business.

Integration with Other GuidingCare Modules

The Appeals and Grievances module integrates seamlessly with the CM, UM and Population Health modules, enabling all stakeholders to track appeals in progress alongside member demographics, enrollment, encounter and care planning information.